Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

The State of Global Mental Health Services

Author(s): B. Saraceno 1
Affiliation(s): 1WHO, Geneva, Switzerland
Key messages:

1 – Mental, neurological, and substance use (MNS) disorders are prevalent in all regions of the world and are major contributors to morbidity and premature mortality.
2 – The resources that have been provided to tackle the huge burden of MNS disorders are insufficient, inequitably distributed, and inefficiently used and this generates a serious treatment gap.
3 – Success in implementation of the programme rests, first and foremost, on political commitment at the highest level.

Summary (max 100 words):

Mental, neurological, and substance use (MNS) disorders are prevalent in all regions of the world and are major contributors to morbidity and premature mortality. The stigma and violations of human rights directed towards people with these disorders compounds the problem. The resources that have been provided to tackle the huge burden of MNS disorders are insufficient, inequitably distributed, and inefficiently used, which leads to a treatment gap of more than 75% in many countries with low and lower middle incomes. The World Health Organization (WHO) has recognized the need for action to reduce the burden, and to enhance the capacity of Member States to respond to this growing challenge. The objectives of the WHO’s programme are to reinforce the commitment of all stakeholders to increase the allocation of financial and human resources for care of MNS disorders and to achieve higher coverage with key interventions especially in the countries with low and lower middle incomes. The Programme attempts to deliver an integrated package of interventions, and takes into account existing and possible barriers for scaling up care. Priority conditions were identified on the basis that they represented a high burden (in terms of mortality, morbidity, and disability); caused large economic costs; or were associated with violations of human rights. These priority conditions are depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children. The obstacles that hinder the widespread implementation of these interventions must also be considered, together with the options that are available to deal with these. Success in implementation of the programme rests, first and foremost, on political commitment at the highest level. One way to begin to achieve this is to establish a core group of key stakeholders who have multidisciplinary expertise to guide the process. Assessment of needs and resources by use of a situation analysis can help to understand of the needs related to MNS disorders and the relevant health care, and thus to guide effective prioritization and phasing of interventions and strengthening of their implementation. Development of a policy and legislative infrastructure will be important to address MNS disorders and to promote and protect the human rights of people with these disorders. Decisions will need to be made as to how best to deliver the chosen interventions at health facility, community, and household levels to ensure high quality and equitable coverage.

Conclusion (max 400 words):

Successful scaling up is the joint responsibility of governments, health professionals, civil society, communities, and families, with support from the international community. An urgent commitment is needed from all partners to respond to this urgent public health need.

Lessons learned:

Adequate human resources will be needed to deliver the intervention package. Most countries with low and middle incomes do not assign adequate financial resources for care of MNS disorders. Resources for delivery of services for these disorders can be mobilized from various sources – e.g. by attempts to increase the proportion allocated to these conditions in national health budgets; by reallocation of funds from other activities; and from external funding, such as that provided through developmental aid, bilateral and multilateral agencies, and foundations.

Making It Better: NZ GPs Improving Access to Elective Services and Bridging the Primary/Secondary Gap

Author(s): R. S. J. Gellatly*1, R. Naden1, c. Perry1, J. Palmer1
Affiliation(s): 1Elective Service team, Ministry of Health, Wellington, New Zealand
Keywords: GPs (general practitioners), primary/secondary interface, GP Liaisons, elective services
Background:

Ministry of Health committed to improving elective services waiting times from 1999.The idea of using GP Liaisons (GPs who liaise) to assist this work came from an article in the BMJ. Since the inception of the role, changes in the NZ health system such as District Health Boards being responsible for regional health needs (rather than a focus on hospital services only) and the implementation of the primary healthcare strategy require better communication across that interface.GPLs now have a broad range of activities in improving the patient journey across the primary/secondary interface.

Summary/Objectives:

The range of roles and activities of GPLs around the country will be described, in relation to various sized district health boards in urban and rural New Zealand. Examples of improvements in which GPLs have been involved will be detailed, such as triaging referrals, changing pathways to improve patient access, providing a primary care perspective in hospital settings. Opportunities for further collaboration and innovation will be highlighted.

Results:

Elective service access has been improved. One of the factors in this has been GP Liaisons. As hospital-based consultants and administration staff gain confidence working with GPLs, other areas for improvement are identified. These vary with the local areas needs. Primary care benefits from having a voice in the hospital and a recognised conduit for issues and ideas to be raised.

Lessons learned:

Building relationships based on improved outcomes has opened up communication across the primary/secondary interface. GPs have a combination of practical can-do attitude, experience of working in both primary and secondary care, and the ability to see the big picture in the complex system that is healthcare delivery. Supporting the GPL network is important for its success. GPLs use many tools gleaned from leaders in health. Having paid time in the day is also a success factor.

Evaluation of Different Types of Community Health Centres in China: Is There Any Disparity in Delivering Their Services?

Author(s): H. H. Dib*1, P. Sun2, Q. Liu3, J. Chen4
Affiliation(s):

1Health Care Management, Dalian Medical University, 2Graduate M.Sc Research nursing department, Second hospital affiliated with Dalian Medical University, 3Statistics department, School of Public Health, 4Vice Dean, School of Graduate Studies, Dalian Medical University, Dalian, China

Keywords:

Community health centres (CHC), yearly revenues, medical drug revenues, Private-owned and State-owned CHCs

Background:

Investigate the performance of two types of Community Health Centres (CHCs): Private (individual-owned and operated or Factory-sublet CHC to private and operated) and State-owned community health centres (Factory owned and operated; Hospital owned and operated) within the city of Dalian, Liaoning province.

Summary/Objectives:

Total 58 community health centres were surveyed studying patients’ turnover, cost of medical drugs and total drug’s revenue, number and types of staff’s specialty (orthopaedics, preventive medicine, dermatologists, cardiologists, Endocrinologists, Gastro-enterologists, Respiratory medicine OB/GYN, GP), number of community nurses and their years of experience, yearly revenue, medical IT filing system and/or recorded paper filing, ownership of high tech equipments, and two tier referral system, physicians and nurses level of education.

Results:

1– Higher revenues among private-owned community centres than state-owned centres (P<0.001).
2– Higher medical drugs costs and drug revenues in the State-owned then in the private CHCs (P<0.05).
3– Higher patients’ turnover among state-owned then the private-owned CHCs (P<0.001).
4– Higher percentage of old-aged people then middle age and young attending State-owned than in the private CHCs (P< 0.05).
5– Less specialized professional staff and more GP role within the State than the private-owned CHCs (P<0.0001).
6– Number of community nurses is higher in the State-owned than the private CHCs (P<0.0001), while the level of education of nurses was higher in the private than in the State-owned (P<0.0001), but training as GP nurses found more in the state owned than the private owned CHCs (P<0.0001).
7– Gender distribution was higher in females than males among the two types of CHCs (P>0.05).
8– Presence of hi-tech equipments were higher in the state owned than in the private CHCs (P<0.05).
9– Nearly absence of IT filing system in the state-owned than in the private CHCs (P<0.05).
10– Sate-owned centres witnessed more referrals to and from the hospitals than the private centres
11– There was no significant difference between the State and private in delivering the six functions services (P>0.05).
12– Under CHCs charges there was no significant differences in physicians’ consultation, opening patient’s file and physical examination-free of charge (P>0.05); while there was significant difference in service charges concerning blood tests, x-ray and ultrasound fees, dentistry treatment (tooth extraction and filling), surgical treatment-cast fixation (P<0.0001).
13– There was total absence of IT connecting system of CHCs with each other in each district (P>0.05)

Lessons learned:

There are great potentials for improvement in delivering the CHCs’ services through increasing community nurses training, opening more training for GP and family medicine physicians to serve better the community, introduce more hi-tech medical equipments, widening the scope of population coverage, and enhance the referral system between hospitals and CHCs.

Policy Analysis of Community-Based Organisations as Providers of Community Health Services: The Case of Four Districts in Malawi

Author(s): L. J. Nyirenda*1, P. Nkhonjera1, B. N. Simwaka1
Affiliation(s): 1Research for Equity and Community Health Trust, Lilongwe, Malawi
Keywords: CBOs, CHBC, CHBC Policy, sustainability, health system
Background:

Malawi is currently experiencing an acute healthcare worker crisis taking place in a context of severe HIV/AIDS epidemic with 14% of the 12 million total population infected by HIV. While the formal health system structures are not easily accessible by most Malawians, there are several close-to-communities providers known as community based organizations (CBOs) linked to HIV/AIDS. Although CBOs provide a clear framework for reaching the poor rural masses there is little evidence on mechanisms of sustainability, integration and linkage with the health system. The weakening and eventual collapse of CBOs might worsen the health worker crisis. This might mostly affect the poor and those residing in rural areas as they are the major beneficiaries of services provided by CBOs. This study set out to investigate factors within CBOs that are necessary for the sustainability of the organizations mainly in the delivery of Community Home Based Care (CHBC). Methods used for the study were focus group discussions, in-depth interviews and desk review of relevant documents and publications. A framework of analysis was used to summarise the findings into different themes and sub-themes.

Summary/Objectives:

1–To find out the knowledge of existence of the CHBC policy amongst different stakeholders.
2– To investigate coordination mechanism for CHBC activities in Malawi.
3– To determine the extent to which funding towards CHBC activities is sustainable.
4– To find out the nature and existence of linkage between CBOs providing CHBC and the formal health system as well as the strength or weaknesses of such links.

Results:

There was poor knowledge and lack of dissemination of CHBC policy amongst stakeholders. Although each district claimed existence of CHBC coordinator, there was poor coordination for CHBCs activities and stakeholders at all levels (national and district), despite existence of policy. This is exacerbated by lack of clarity as to which Ministry or department is appropriate to host the CHBC coordinator and reporting line. Most officials admitted that they were not sure as to who was the overall in-charge of CBO activities including CHBC. It appeared, however, that stakeholders with resources at a particular time were the ones wielding power and reports covering different activities were being sent to such stake-holders. Most CBOs depend on grant facility funding from National AIDS Commission (NAC) grants and other NGOs.  There are weak links between the CBOs and the formal health systems; no formal referral mechanism and reporting exist. Most Health Surveillance Assistants (HSA) who are supposed to link the HBC work at community level with hospitals and health centres are not trained in CHBC work and are ignored in most of the activities carried out by CBOs. Communication is a huge challenge amongst stakeholders. For instance, some health centres turn away CHBC volunteers when the latter go there to replenish their drug and material stocks.

Lessons learned:

CBOs remain an indispensable part of the health system in the context of an acute shortage of trained/professional health workers. But without proper coordination and predictable funding, they are bound to provide the worst services to their beneficiaries. Such services would perpetuate inequities as the people accessing such services would be the poor and those who mostly reside in villages. Expecting organizations like CBOs to report to different stakeholders on different issues can bring about confusion; CBOs are mostly run by lowly qualified people who work on voluntary basis.

Strengthening Health Systems through Formal Links with Storekeepers, Volunteers and Community Health Committees in Urban Settings: Extending Services to Communities Project

Author(s):

B. M. Nhlema Simwaka*1, P. Nkhonjera1, A. Willetts2, F. M. L. Salaniponi3, R. Malmborg4, S. R. Theobald2, B. S. Squire2

Affiliation(s):

1Research for Equity And Community Health Trust, Lilongwe, Malawi, 2Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 3National TB Control Programme, Ministry of Health, Lilongwe, Malawi, 4Norwegian Health and Lung Patient Association, Oslo, Norway

Keywords: Health system, informal health providers, referral, tuberculosis
Background:

This abstract highlights finding of an intervention research called Extending Services to Communities. The aim of the study was to document the impact of improving the advisory, referral and health promotion skills of storekeepers, volunteers, and community health committee in improving early care seeking for tuberculosis. The intervention package included a capacity building, referral system between the community and health facilities and health promotion on tuberculosis and chronic cough.

Summary/Objectives:

The objectives of the study were: (1) To develop and implement the Extending Services intervention package. (2) To analyse the acceptability of the intervention by the different stakeholders involved in implementation. (3) To explore, through gender and poverty analysis, the community perspectives of the impact of the intervention. (4) To quantify the extent of the impact of the intervention on TB control indicators. (5) To make recommendations for approaches for implementing and evaluating similar community based health interventions.
The research was conducted in Malawi by Research for Equity and Community Health Trust, in three resource-poor settings of urban Lilongwe in collaboration with the National TB Control Programme, Lilongwe District Health Office and City Assembly. The first intervention area was Ngwenya and second area was Kauma. Kauma was used to test replicability of the intervention. Chinsapo was used as a control area. The multi-method approach was used to develop and implement the intervention and to evaluate its impact and acceptability from social and biomedical perspectives.

Results:

A participatory process promoted ownership of the intervention and improved the referral and health promotion skills of storekeepers, volunteers and community health committees. Health workers used the referral letters as a screening tool for tuberculosis. The major limitations were coverage of health promotion activities and the participation of men in these activities. The community members explained that the intervention had greater impact on the poor men and women than the poorest because of the nature of their livelihood activities. In the intervention areas there was a significant increase between 2003 and 2006 in the proportion of chronic coughers seeking care within two weeks of symptom onset (Kauma from 23.4% to 68.8%, [p=0.001]; Ngwenya from 9.3% to 30.8 %, [p=0.042]) compared with the control area where the change did not reach statistical significance (Chinsapo from 36.9% to 15.4%, [p=0.0142]). In addition the proportion of Lilongwe city’s total annual notifications of smear positive TB arising from the intervention areas rose significantly (Kauma from 0.2% to 1.3%, [p=0.002], Ngwenya from 1.4% to 3.2%, [p=0.004]) while the proportion reported from the control area did not rise significantly (Chinsapo from 2.7% to 3.3%[p=0.44]).

Lessons learned:

The multi-method approach helped to understand the impact of the intervention on access to services from different perspectives and in framing different research outputs for different audiences. It was also clear that integration of the informal health providers to the formal health system depended on building on their existing roles as early entry points into the health system for poor men and women and was not intended as a way of replacing the role of the health workers. The Extending Services to Communities Model is one way of strengthening the health system to increase access to elements of the Essential Health Package. Meaningful integration calls for embracing of both biomedical and social models of health.

A Model for the Integration of Primary Healthcare Services in KwaZulu-Natal, South Africa

Author(s): M. N. Sibiya*1
Affiliation(s): 1Nursing, Child and Youth and Environmental Health, Durban University of Technology, Durban, South Africa
Keywords: Primary healthcare, integration, district health system, South Africa, grounded theory approach
Background:

The redirection of the healthcare system towards Primary Health Care (PHC) along with the concomitant establishment of the District Health System (DHS)as a framework for PHC delivery and management has been the transformation event in the public health sphere in South Africa since 1994. On the other side, this move towards transforming the healthcare system has been met with numerous impediments, flaws and failures, many of which have not yet been mastered, solved or ironed out. As equity and access to healthcare have since 1994 been considered the key principle to steer the transformation of health services in South Africa, a mechanism was required to define parameters for service delivery, as well as to ensure comparability in the rendering of services. This mechanism realized in the form comprehensive PHC service package that was introduced by the National Department of Health in 2001. Whereas in the past in the South Africa, the model of PHC delivery was strongly based on a vertical approach, the PHC package envisages an organization of services that allows for a one-stop approach. The comprehensive PHC service package is aimed at defining services per level of facility as a way to maximize the integration of services. Nevertheless, integration of PHC services continues to be seen as a pivotal strategy towards the achievement of the national goals of transformation of health services, and the attainment of a comprehensive and seamless public health system. The problem, however, arises in the implementation of integrated PHC as there is no agreed upon understanding of what this phenomenon mean in the South African context. To date no re- search studies have been reported on the meaning of the integration of PHC services. Hence, there is a need for shared views on this phenomenon in order to facilitate an effective implementation of this approach.

Summary/Objectives:

The purpose of the study was to analyse the integrated PHC (IPHC) within a DHS in South Africa and thus the shared meaning of the phenomenon. Ultimately the aim is to develop a model for the integration of PHC programmes in KwaZulu-Natal.

Results:

Grounded theory approach was used to guide the research process. Theoretical selection of clinics located within four health districts in KwaZulu-Natal was done. Data were collected by means of observation, interviews and document analysis. The results indicated that the majority of the clinics offered most of the services that are listed on the comprehensive PHC core package although the process of implementing the integration of PHC services was done differently in all the clinics where observations were done. All participants interviewed understood the IPHC services as provision of all services in the clinic as stated in the comprehensive PHC core package. However, they expressed different views regarding the process of provision of these services. From the data sources, it emerged that the need for the integration of PHC services in South Africa arose as a response to health needs of the community, the shortage of staff and limited infrastructure and the fragmentation of PHC services. The results also indicated that IPHC resulted in improved accessibility of services. However, on the contrary the unintended consequences of integration were reported to be overcrowding in the clinics thus resulting in deteriorating quality of patient care.

Lessons learned:

These are the preliminary results of the study. The researcher is still in the process of identifying the emerging categories that she will use in developing a model. Supermarket approach, one stop shop and comprehensive services emerged as conceptual categories for understanding integration of PHC services from the data analysis process. The researcher noted that the interviewees used the terms ‘supermarket approach and one stop shop’ interchangeably.

New Ways to Achieve Primary Healthcare in India: A Critical Review of National Rural Health Mission

Author(s): K. R. Nayar*1
Affiliation(s): 1Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
Keywords: Primary healthcare, health services system, India
Background:

The idea of a health ‘worker’ from the community is not a new one; from a public health point of view, it may be an ideal vehicle for another development in the field. But it failed miserably in the case of the Community Health Guide/Volunteer (CHV) scheme due to several reasons. The most serious problem with the CHV scheme was the selection process; it was misused to distribute political patronage and even close relatives of panchayat leaders were selected. The training was extremely limited but in the course of time, most of the CHVs became quacks. A programme meant to give ‘people’s health in people’s hands’ ended up as mere quackery. It is against this background that the government introduced the National Rural Health Mission (NRHM) which includes a women’s community health volunteer called Accredited Social Health Activist (ASHA).

Summary/Objectives:

This paper critically reviews the National Rural Health Mission from a public health perspective as well as based on the ideals of Primary Health Care (PHC).

Results:

The key strategies of the Rural Health Mission include: ensuring intra- and inter-sectoral convergence, strengthening public health infrastructure, increasing community ownership, creating a village level cadre of health workers, fostering public-private partnerships, emphasizing quality services and enhanced programme management inputs.. Community participation will be enhanced by giving functional responsibilities and powers to the panchayati raj (local self-government) institutions, apart from creating a cadre of voluntary accredited social health activists, and a drug and contraceptive depot at the village. The mission will also use management experts, Chartered Accountants, Business management specialists and GIS specialists for its management units.
We find that the utter neglect of primary care and primary healthcare institutions has influenced the utilization of health services and contributed to the worsening epidemiological profile in the country in recent years. In the present form, the proposed mission adds to the confusion about the approach to healthcare in the country. Cost-effective interventions such as the rational distribution of financial and medical resources, including drugs, effective manpower distribution and primary healthcare approaches, should be part of the vision.

Lessons learned:

This paper recommends that a vision that gives primacy or rather credibility to the vast network of health institutions that the country has built over years is needed. Strengthening the sub-centres and equipping the government’s own health workers (instead of adding posts) would be epidemiologically and economically more effective. States should be allowed to define their own priorities and plan programmes. At present the public health scenario is extremely nebulous and the differential pattern across states is so glaring that it does not allow the imposition of pan-Indian solutions.  Apart from this, there is also a need to equip and enable elected representatives at the village and block level for handling health issues. Presently, health programmes are beyond the reach of people who are supposed to govern under the decentralised form of government as these are often considered technical subjects. There is a need to remove the confusion among representatives and officials at the panchayat (local self-government) level about the roles and responsibilities around health services. This paper concludes that initiatives such as the rural health mission would greatly benefit if it follows the vision of those that scripted India’s health service system based on an integrated and unified approach as against the selective interventions being proposed in recent years.

Local Planning: An Experience of a Primary Care Centre in Florianópolis, Brazil

Author(s): C. M. S. Moutihno, Jr1
Affiliation(s): 1Public Health Department, Municipal Health, Florianópolis, Brazil
Keywords: Primary Care, health planning, Family Health Strategy
Background:

The project of health planning at the Primary Health Center Lagoa da Conceição, in Florianópolis (Brazil) emerged as a need to change a model of care assistance, based on the spontaneous demand and a limited scope in the practice of health (passive attitude) for a model of Family Health Strategy, with shares epidemiological data on a defined territory and organizes a supply of services, expanding the community’s access to health services (pro-active attitude). The planning tool enabled changes on the organization for the work process in the primary care of the Family Health Teams (FHT).

Summary/Objectives:

The indicators available have been raised using SIAB (Information System in Primary Attention), SIM (Information System in Mortality), SINASC (Information System of Births), and HIPERDIA (Information System of hypertensive and diabetic people). There were used the following indicators:
1– Medical care / team resolution: consultations pop / year, the average time, total resolution, average visits / family.
2– Women/Children: exclusive breastfeeding, pregnant beginning the 1st quarter, pregnant medical/nursery care in the month, pregnant <20 years, low weight at birth, pregnant with more than 4 and 7 consultations in the prenatal, procedures Papanicolau / pop fem.
3– Hypertensive/ Diabetic people: lifting risk of disease DAC in 10 years, using of Framingham Score.
The objectives were:
1– Work with a common goal for the actors involved in the planning (FHT); stimulate work as a team
2– Develop the diagnosis of the current situation, with survey data; study of the data and dynamics of monitoring / update-dynamic planning
3– Improve health indicators of the population.

Results:
Lessons learned:

Understanding Client Satisfaction: Does Quality of Care Matter? Findings from Maharashtra and Rajasthan

Author(s): S. Ghosh*1, R. Acharya2, S. Kalyanwala2, S. Jejeebhoy2
Affiliation(s): 1Development Studies, Institute of Development Studies Kolkata, Kolkata, 2Youth and Adolescent Health, Population Council, New Delhi, India
Keywords: Client satisfaction, quality of care, provider’s behaviour, healthcare services
Background:

An increasing attention has been paid to client’s perspective of quality of care to enhance effectiveness of healthcare delivery system in the developing countries in the recent past. Assessing client’s perspectives give user a voice and would make health services more responsive to people’s needs and expectations. Evidences in developing countries suggest that healthcare utilization is sensitive to user perceptions of quality. Studies of women’s reports of quality of healthcare in India have largely focused on family planning services. Less is known about women’s satisfaction with or quality of care received in general health, maternal health or child immunization services.

Summary/Objectives:

Objectives of the present study are to assess factors associated with clients’ perceived satisfaction in accessing general healthcare (GHC), maternal healthcare (MH), family planning services (FP) and, child immunization (CI) at the individual and facility levels in two states of India.  A survey, comprising exit interviews with 2903 women attending 153 PHCs in two districts each of Maharashtra and Rajasthan, was conducted as part of a larger programme on Comprehensive Abortion Care. Several dimensions of perceived quality of services were probed, including women’s perceptions regarding quality of interaction with the doctor and other staff members; the adequacy of information provided; whether the importance of follow-up was discussed; average waiting time and time spent in consultation. Additionally, a measure assesses the quality of the facility, including availability of doctor, availability of visual privacy during consultation, availability of waiting facility, cleanliness of the out-patient department (OPD) and in-patient facilities. Multilevel logistic regression analyses explore the contribution of each of these measures to client satisfaction with each of the three different types of services received. Other explanatory factors include clients’ background characteristics and state of residence.

Results:

Most of the quality dimensions have a positive and statistically significant effect on patient satisfaction for all types of healthcare services in varying degree. Provider behaviour emerges as the most significant predictor of client satisfaction in all three services. Other quality dimension variables such as assurance regarding follow-up services, providing medical information and waiting time in obtaining services have significant effect on perceived satisfaction in the expected direction. Significant among background factors, moreover, is residence in Maharashtra.

Lessons learned:

The present study has identified some quality dimensions of perceived satisfaction. These dimensions provide information on the structure and the process of care. These dimensions are important areas in which health services in India require strengthening. However, it would be wrong to infer that some quality dimensions can be ignored in favour of others. These different dimensions are interdependent and improvements in one area likely to strengthen the other. Findings reiterate the link between quality of services and care and client satisfaction and single out provider attitudes and interaction with clients as a key factor shaping client satisfaction and consequently utilization of public healthcare system.

Evidence-Based Preventive Screening as a Part of Healthcare in the Workplace: Russian Experience

Author(s): A. V. Kontsevaya1
Affiliation(s): 1Department of developing technologies of preventive programmes, National research centre of preventive medicine, Moscow, Russian Federation
Keywords: Preventive screening, healthcare, workplace
Background:

Cardiovascular risk factors appear in early stages of life and high cardiovascular risk may be in men and women of young and middle age. These people don’t yet have symptomatic diseases and they are very busy with their job and family affairs and do not think about their health. But primary prevention interventions can be very effective in this population. The probable way of solving this problem is providing healthcare on the workplace of these people. Healthcare system on the work place should be preventive and allow revealing people with high cardiovascular risk and early stages of chronic diseases with help of evidence-based methods, but it also should not occupy a lot of time. Computer-based system of preventive screening for working collectives was conducted in National research centre of preventive medicine (Moscow, Russia).

Summary/Objectives:

To study the effectiveness of evidence-based preventive screening as a part of healthcare on the working place for cardiovascular risk assessment and revealing early stages of chronic diseases. Survey with computer-based system of questionnaires (WHO questionnaires on CHD, chronic obstructive pulmonary disease, diabetes (COPD), HADS and Ridders questionnaires) were performed. Objective measurements included anthropometry, tonometry, cholesterol and glucose measurement. Cardiovascular risk level was estimated by standard criteria (SCORE).

Results:

The study was conducted in two working collectives: high school teacher (234 persons, aged from 30 to 60 who worked in Ivanovo state architecture academy). These collective was chosen because these are social important workers this rather low salary. The prevalence of high cardiovascular risk was 44.9%. Positive results of Rose questionnaire were revealed in 6.4% study participants (in 54.5% of them it was new diagnose). Hypertension was revealed in 46.6% of high school teachers (in 34.2% of them it was new diagnosis). Also, positive results of the questionnaire on COPD were revealed in 4.7 % of high school teachers (in 64.3% of them it was new diagnosis). Before the survey only 0.9% persons checked their cholesterol and knew its value, hypercholesterolemia was revealed in 45.3%.

Lessons learned:

Middle age working collectives are characterized by high cardiovascular risk and high prevalence of undiagnosed chronic diseases. Early detection of this situation and early and effective interventions can help to prevent cardiovascular events and prolong working years. Computer-based preventive screening is effective tool of cardiovascular risk assessment and revealing of early stage chronic diseases, which may be a keystone of conducting preventive strategies in working collectives.